The Whedon Effect

Why is it that male feminists so often treat women badly? What they're thinking: I have the right beliefs, therefore I'm the good guy, therefore I can rest on my laurels and pay no attention to how I treat the actual women in my life.

"I'm pro-choice (and I swear not just because it leads to more sex)." "Okay, let's have sex. Do you have a condom?" Of course not. He doesn't like condoms. I guess I can get an abortion. And pay for it myself. 

His feminism means asserting his dominance over non-feminist men. It doesn't mean that he feels any heightened obligation to women, or that he even bothers to notice women's feelings. Examples: the male feminist who proposed an open relationship to me, where "open" would mean he got to have sex with anyone he wanted, and I got to have sex with...him. Or the one who somewhat horrifyingly told me he knew I wanted to have sex with him because of the color of my dress. Isn't that...rape culture? I did want to have sex with him, but that's irrelevant.

What if, instead of going around knowing you have the socially acceptable beliefs, you knew you had the wrong beliefs? What attitude would you have? My theory is that this might inspire you to be more careful and courteous with others. You can't assume you're the good guy, you have to prove it. This is the type of guy I've had success with. Of course, an alternative theory is that non-feminist men are actually motivated by chivalry more than courtesy, so that I am benefiting from the kind of sexism I object to. 

Rating Ulysses

Do we rate Ulysses S Grant as a poor president, because he was incompetent, drunk and, if not corrupt, tolerated corruption, or as a good president, because he said the right things about race?

His early military career showed flashes of brilliance before he resigned from a post in California amid accusations, almost certainly justified, of drunkenness. He then failed at various business ventures, a lifelong tendency that accompanied a penchant for trusting swindlers. Not long before the civil war he was virtually broke, walking the streets of St Louis in shabby clothing selling firewood.

I may be more comfortable with my flaws than most. When told, "X company is better than most because they filter out the assholes," I thought, oh, I shouldn't apply there. They don't like people like me.

Carlyle's Vocabulary

Word	Definition
culminant	Of a heavenly body: That has reached its greatest altitude, that is on the meridian; hence fig. that is at its greatest height.
whinstone	A name for various very hard dark-coloured rocks or stones, as greenstone, basalt, chert, or quartzose sandstone.
shaveling	A contemptuous epithet for a tonsured ecclesiastic. (Very common in 16th and 17th c.)
fingent	Given to fashioning or moulding.
losel	A worthless person; a profligate, rake, scoundrel; in weaker sense, a ragamuffin, ne'er-do-well.
edacity	The quality of being edacious; capacity for eating; good appetite. or Corrosive quality, destructive power. Obs.
gulosity	Gluttony, greediness, voracity.
eleutheromaniac	one possessed by a mad zeal for freedom
fremescence	An incipient roaring.
fremescent	Murmuring, growing noisy.
grunsel	groundsel OR ground-sill
tripudiation	the action of dancing or leaping, esp. in token of joy or excitement; exultation.
weasand	The œsophagus or gullet.
obtest	To call upon in the name of something sacred; to charge solemnly, adjure; to beg earnestly, beseech, entreat, or implore (a person). Freq. with infinitive or that-clause as complement.
spontoon	A species of half-pike or halberd carried by infantry officers in the 18th century (from about 1740).
furibund	Furious, raging, mad.
scorine	????
bando	A public proclamation. Obs.
divulsive	Tending to tear apart or asunder.
handsel	To give (a person) a gift at the beginning of the year or day, on a birthday, etc., as a token of good luck. Also more generally: to give a gift on any occasion. Formerly also in ironic use: †to present or greet with something unwelcome (obs.).
scission	Division of a previously united body of people into mutually opposing parties; a split, a schism.
passe-partout	Originally: †a person who may go anywhere (obs.). Subsequently: a thing giving a person the right or opportunity to go anywhere; spec. a key that opens any or many doors, a master key; (occas.) a passport. Freq. in extended use and fig.
footling	Trivial, pointless; (of a person) that footles or trifles.
adust	Originally: affected with, or having a temperament determined by, adust humours (see sense 1a). In later use: having a melancholy character or appearance; gloomy; sallow. Obs. or That is in a dusty condition; covered in dust. or To burn, to scorch; to desiccate by exposing to strong heat. Also fig.
demit	trans. To send, put, or let down; to cause to descend; to lower.
phasis	esp. any particular aspect of a thing of varying appearances. Obs.
bob-miner	????
mittimus	Law. A warrant issued by a justice of the peace, etc., committing a person to custody. Now hist. exc. in U.S. or trans. To commit to prison by a warrant. Obs. rare.
apophthegm	A terse, pointed saying, embodying an important truth in few words; a pithy or sententious maxim.
brayed ware	a confusion for braided ware = damaged or faded goods;
epicedium	A funeral ode; a lament over a dead person. Also in figurative contexts.
ferula	The giant fennel or From the use of the fennel-stalk in Roman times: A cane, rod, or other instrument of punishment, esp. a flat piece of wood (see ferule n. 2); fig. school discipline.
abutment	The point at which something abuts upon something else; a point of junction or meeting; a boundary. Also: a property or piece of land that abuts upon another; a description or record of how one property abuts upon another.
escarpment	Geol. ‘The abrupt face or cliff of a ridge or hill range’ (Page). Also attrib.
hodden	Woollen cloth of a coarse quality such as used to be made by country weavers on their hand-looms.
door-rabbet	A piece of stone (or occasionally timber) cut and shaped so as to form one side of an opening in a wall and accommodate a door, gate, window, or chimney;
fugle	To cheat, trick.
glen	A mountain-valley, usually narrow and forming the course of a stream.
shackly	Shaky, rickety; ramshackle.
hobbledehoy	A youth at the age between boyhood and manhood, a stripling; esp. a clumsy or awkward youth.
wynd	A narrow street or passage turning off from a main thoroughfare; a narrow cross-street; a lane or alley.
gillies	An attendant on a Highland chief. Now hist.
forehanded	That has made provision for the future; in easy circumstances, ‘well-to-do’. Now only U.S.
puncheon	A tool or machine for stamping a design on an object or A short upright piece of timber in a wooden framing to provide stiffening or support; a supporting post, spec. a post supporting the roof in a coal mine. or A split log or rough piece of timber with one smoothed surface, used esp. for flooring and corduroy roads, and formerly for buildings;
cheval-de-frise	A defensive appliance of war, employed chiefly to check cavalry charges, and stop breaches; a large piece of Timber pierc'd, and travers'd with wooden Spikes, arm'd or pointed with Iron, five or six Foot long.

On being likable

It's occurred to me lately that some people like me. I don't mean people being friendly to me because they want to have sex with me, or because they're trying to be professional, or because they're generally friendly people. I think--and bear with me here--that some people actually enjoy my company for its own sake. So much of our socializing is somewhat forced--you hang out with people because they are in the same school, or workplace, or social group. I always thought that I was being tolerated as part of the group. But--maybe--not always?

This opens up whole new vistas for me. The best I generally expect of other people is that they will tolerate me if I am quiet and don't cause trouble. (Legacy of a childhood being told to talk more, and then told I was crazy when I talked.) What would it be like if I instead believed that there was a real possibility some people would enjoy being around me?

Deep question. I wish I had known this earlier. I've started reaching out to people a bit more as a result. A friend called me this morning and I called him right back. On the telephone!

Ideologies are Teams

If an ideology is correct, everyone who believes in that ideology is a good person. Therefore, a feminist can never do bad things to women. And a conservative can never break the law.

If an ideology is correct, it must disagree with every incorrect ideology. If you believe in an incorrect ideology, you cannot simultaneously believe in a correct one, even on different topics.

The Victim/Villain Fallacy

There are two sides to every question: Red Team and Blue Team. You get to pick which side you're on, but you have to be on a side. You can't be neutral and you can't be for or against both sides.

What if I really, really hate them both? Response: If you were a right-thinking person, you'd be on the Red Team. Staying neutral means you must be Blue.

Can I be on Team Blue and still think their coach sucks? No. Picking a team means you are endorsing everything they currently do and everything they've done in the past, even before you were born.

One team is 100% innocent, the other team is 100% guilty. I say, "Red Team cheated!" This reveals I am on Team Blue. What if Red Team really did cheat? Doesn't matter. My saying something bad about Red is enough to establish I am Blue. The truth value of what I said, or whether I believe it to be true, doesn't matter.

Another way to play this game is the "How can you compare?" tack.

Me: "Red Team Player got arrested for beating up his girlfriend. They should fire him!" 


Response: "That's nothing! Blue Team Player murdered six women! How can you compare them?"


Me: "Murder is indeed worse than assault. Okay, fire Blue Team Player too."


Response: "Good. I'm glad we agree Red Team Player did nothing wrong."

What if I try to say something nuanced, like "Red Team has a great goalie but Blue Team has better offense"?

Two possible responses: you can choose not to remember part of this statement. "She said, AND I QUOTE, "Red Team has a great goalie." Therefore, she's on the Red side."

Or, you can assume bad faith. "She's trying to sound fair and balanced, but she can't really believe Blue has good offensive players; if she did, she'd be Blue, and we know she's not Blue, because she said something good about Red."

I don't know how to win this game. So far I just settle for pointing it out.

Psychosomatic illness: final post

Physical manifestations of unhappiness are something we all experience; they are not personality flaws or signs of weakness, they are a part of life. Life is hard sometimes. It is harder for some than for others. We all manifest that hardship in different ways.

Each of these diagnoses is considered either entirely medically unexplained or only partially explained and with a large psychological component:
 
Amalgam poisoning, irritable bowel syndrome, candida syndrome, chronic fatigue syndrome, fibromyalgia, chronic Lyme disease, Morgellon's syndrome, formication, electromagnetic poisoning, environmental or chemical sensitivities, food intolerance.

 I recently went to a dinner party where every person bar two, at a table of ten, reported that they had an intolerance of or allergy to at least one foodstuff. Most had developed the allergy in middle age, which is not how an allergy typically behaves...People look for explanations for changes in their bodies, something to account for every unpleasant feeling. There is an unwillingness to accept behavioral or emotional factors, or the effects of aging, as an explanation. Society and the media are often available to provide a more agreeable answer and to add to the symptom pool available

The question that we, the unaffected, must answer for ourselves is, can we give a disability that has its roots in behavioral or psychological factors the same respect that we offer to a physical disease? If the answer is yes, then none of the other controversies matter any longer.

The placebo effect is another illustration of the mind-body connection--you might call it the psychogenic cure. Also widely and deeply misunderstood. Did you know, for instance, that the placebo effect works even if you are aware of it? Understanding this makes me skeptical of some of the self-experimentation people sometimes do. "Try X, it worked for me!" is a terrible, terrible argument. And it remains terrible no matter how much useless precision the author gives you about so many milligrams of whatever at whatever time of day immediately after exercise. I'm looking at you, Tim Ferriss! (Scott Alexander is also guilty of this to a lesser extent.) Did you do a randomized double-blind study on yourself? I don't fucking think so. You have no idea whether a given treatment worked on your body or your mind.

This doesn't mean that you should never try unproven remedies. My personal conclusion is that we should pay a lot more attention to the costs of the treatments we choose. Lots of home remedies are acceptable for this reason. If you think that valerian tea helps you sleep or ginger ale alleviates nausea, go ahead and use it without worrying too much about randomized controlled trials—your cost is only a small amount of money and trouble. In other words, the cost-benefit ratio is more likely favorable when the cost is negligible.

But with treatments that are much more costly, such as surgery, medications with serious side effects, and any involvement with the mental/behavioral health system, you need to be a lot more careful in assessing the likely benefits. For example, do you think the doubtful benefit of antidepressants is worth the 40-60% chance of loss of libido, to name just one of their costs?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/

I have my own answer to this, of course (sex is great), but my real message is to pay attention to the costs, and to be skeptical of the success stories you hear.

The Victim/Villain Fallacy

There are two sides to every question: Red Team and Blue Team. You get to pick which side you're on, but you have to be on a side. You can't be neutral and you can't be for or against both sides.

What if I really, really hate them both? Well, if you're not on the Red Team, all the Red Teamers will assume you're a dirty Blue Teamer. And, if you're not on the Blue Team, all the Blue Teamers will assume you're an ignorant Red Teamer.

He was constantly defending his Communist friends to his right-wing enemies and his right-wing friends to his Communist enemies, and he was thoroughly detested by both groups, who never defended him to anyone because they thought he was a dope.

—Catch-22

Can I be on Team Blue and still think their coach sucks? No. Picking a team means you are endorsing everything they currently do and everything they've done in the past, even before you were born.

One team is 100% innocent, the other team is 100% guilty. I say, "Red Team cheated!" This reveals I am on Team Blue. What if Red Team really did cheat? Doesn't matter. My saying something bad about Red is enough to establish I am Blue. The truth value of what I said, or whether I believe it to be true, doesn't matter.

Another way to play this game is the "How can you compare?" tack.

Me: "Red Team Player got arrested for beating up his girlfriend. They should fire him!"
Response: "That's nothing! Blue Team Player murdered six women! How can you compare them?"
Me: "Murder is indeed worse than assault. Okay, fire Blue Team Player too."
Response: "Good. I'm glad we agree Red Team Player did nothing wrong."

What if I try to say something nuanced, like "Red Team has a great goalie but Blue Team has better offense"?

Two possible responses: you can choose not to remember part of this statement. "She said, AND I QUOTE, "Red Team has a great goalie." Therefore, she's on the Red side."
Or, you can assume bad faith. "She's trying to sound fair and balanced, but she can't really believe Blue has good offensive players; if she did, she'd be Blue, and we know she's not Blue, because she said something good about Red."

It's easy enough, for leftists, to imagine confronting a mob of racial bigots, McCarthyites, or religious fundamentalists. The harder test is resistance to public opinion in one's own camp.

--Hitchens

I don't know how to win this game. So far I just settle for pointing it out.

Psychosomatic illness 6: the feminist position

I'd like to devote a special post to the feminist objection to the concept of psychosomatic illness. This objection deserves some respect, drawing as it does upon the long and troubled history of women being labelled mentally ill for specious and doubtful reasons. The concept of mental illness is of course a means of social control, and one that has weighed particularly heavily on women. Female eccentrics such as me have often been defined as mad. And of course, women are sometimes called “hysterical” as a pure insult, with no factual content, as when Kamala Harris, the new Senator, was called “hysterical” for her prosecutorial style of questioning a witness. (For more, see Phyllis Chesler, Women and Madness, or Elaine Showalter).

This line of thinking has been popularized in the feminist blogosphere, so that many people have a kneejerk negative reaction to any suggestion that a woman's illness is “all in her head.” Some have gone so far as to conclude that the very word “hysteria” ought to be banned as sexist. These people have never read Breuer.

Because if you read Breuer, or Freud, Charcot, or Janet (okay I've never read Janet), you get the other side of the story of hysteria. Of course mental illness is a means of social control, and I'm generally the first to make that point. But mental illness also causes people to suffer, which is why, even today, most adults who are treated for mental illness undergo that treatment voluntarily. And many of them would still be suffering even in the Feminist Utopia. The vast majority of cases of Victorian/Edwardian hysteria weren't a matter of "she wants a job, she must be crazy," they involved painful and disabling symptoms that any doctor in any era would identify as meaning that Something Is Wrong. Symptoms like paralyzed limbs, weeks of catatonia, hysterical blindness and muteness, inability to eat, seizures, fainting, as well as abilities that some observers saw as supernatural, such as gaining the ability to speak new languages, withstanding needle wounds with no sign of pain, and sustaining bizarre arched postures for hours at a time.

We need, therefore, to treat mental illness, including psychosomatic illness, if we want to help suffering people, but we also need to rein in those who would use mental health care as a tool of oppression. A good rule of thumb is the libertarian principle; let others do what they want with their own minds and bodies as long as they don't harm anyone else. Don't call the police on your suicidal friend; he has the right to die if she wishes. And be very, very skeptical when children, the elderly, or institutionalized people have “treatment” forced upon them by their keepers.

I rate this objection: Half-right.

Poetic Meter and Poetic Form

I'd like to recommend the book Poetic Meter and Poetic Form. This should not be your first book on poetry; it's for the person who already knows that the Petrarchan sonnet differs from the Shakespearian one, but doesn't quite see why it matters. The book was written in a modern age, but with a traditionalist spirit. Some quotes:

The art of poetry is the art of knowing language and people equally well. To do something to the reader is the end of poetry; a poem is less a notation on a page or a sequence of uttered sounds than a shaped and measured formal effect that impinges upon a reader or hearer.

The approximation of structures of reasoning to the shape of the rhyme scheme is one of the most difficult acts in English poetry: indeed, only a few masters of the sonnet in English have managed always to avoid meaningless rhyming.

The notion that convention shows a lack of feeling, and that a poet attains “sincerity” by disregarding convention, is opposed to all the facts of literary experience and history. The individual talent is speechless without the conventions. And without an almost equal understanding of them, the audience, for all its intelligence and good will, hears nothing. “The innocent eye sees nothing.”

And it includes good lessons for the prose writer as well

 A principle governing all events which occur in time is that the middle of the event is the least interesting part, the beginning the next more interesting, and the end the most interesting. Instead of “He is a fool, in my opinion,” say, “He is, in my opinion, a fool.”

But it's true!

BUT IT'S TRUE!

--Me, all of my life

People think that Donald Trump denouncing "violence on both sides" in Charlottesville means he's secretly a Nazi. BUT IT'S TRUE!

We know there was violence on both sides. (Some) leftist counterprotestors showed up to Charlottesville armed and masked. Others bragged about attacking and harassing the other side. I know this from:

---Reputable media sources, such as the Washington Post
---Eyewitness statements, collected by me, Citizen Journalist
---General truths about human nature, i.e., people are stupid and evil, and when you tell them political violence is okay as long as it's against The Enemy, some of them will take you seriously.

Okay, I'm being a little autistic here. Yes, statements by politicians are motivated by more than "is it true." And I realize that empathetic people, who are wrong but numerous, care more about expressing the right feelings than about truth. So call him callous and unempathetic, accuse him of wanting to keep the support of the alt-right...

BUT IT'S TRUE.

People should be allowed to tell the truth without penalty. When you penalize people for speaking the truth, it becomes harder to arrive at the truth.

A friend recently posted something on Facebook, claiming that racism explained why the police were more active in their response to "nonviolent" protests, such as in Ferguson, than in their response to the white nationalist protestors in Charlottesville. I pointed out that the "nonviolent" protests in Ferguson actually involved one person dying, many people being beaten, and many businesses burned and looted. But in my friend's mind, Ferguson was still "nonviolent" because the protestors had good intentions, and the white nationalists were inherently violent because they had bad intentions.

This is what happens when we penalize people for speaking the truth. We lose track of what really happened, and of what words really mean.

Matal v. Tam and offensive speech

This week's case of Matal v. Tam was a challenge to U.S. Patent and Trademark Office rules brought by a California rock band known as The Slants.

• The US PTO will not register trademarks that are “disparaging” to “persons,” because of a rule in the 1946 Lanham Act. What this means is largely left to the discretion of the individual patent examiner. There is, however, a policy that it doesn't matter if the person seeking to register the trademark is a member of the disparaged group of persons. The Slants's schtick is “reclaiming” stereotypes about Asian-Americans; doesn't matter to the PTO, who denied their trademark application as disparaging.
• Simon Tam (frontman of the band) claimed this was a violation of his free speech rights. Conspicuously missing from this case, as with many such test cases, is an explanation for how a minor rock band can afford to go all the way to the Supreme Court. (Amicus brief by the Redskins.)
• I guess some people are just really passionate about protecting their rights, not that I would understand that.
• Query what “disparaging to persons” means. Tam attempted to argue that the regulation should be interpreted to prohibit only trademarks that disparage individual persons. Under this interpretation, you can disparage groups like Asian-Americans, but you can't name your hardware store “The Anti-Walmart,” or your bar “Trump Sucks.” The court found that there was no evidence either in the text or legislative history for this reading.
• Isn't this whole issue why defamation law exists? Should the government really be in the business of protecting people's hurt feelings? Several cases in this area about people who want to use religious trademarks for wine, such as Agnus Dei wine or Madonna wine. Is preventing blasphemy a legitimate function of our government? I of course think not.
• Anyway. The government's best argument is that trademark registration is not individual speech, but government speech, meaning that the First Amendment doesn't apply. No one is putting The Slants' members in prison for using that name; they just can't have a registered trademark.
• It sounds odd to say that the First Amendment doesn't apply at all to government speech, doesn't it? But if you think about it, it would make no sense otherwise. The government speech doctrine is why the government can fund anti-smoking messages without also funding pro-smoking messages, or why the National Endowment for the Arts can fund some artworks but not others. So far so good.
• More debatable cases of government speech: can the government allow certain monuments but not others in a public park? Can the government allow certain messages and not others on license plates? In both cases, yes.
• But the Court is concerned about “dangerous misuse” of this doctrine. License plates and public parks are under the control of the state and identified in the public mind with the state; not so trademarks.
• If trademark registration is government speech, it's incoherent. There are both pro- and anti-abortion trademarks, pro- and anti-capitalist trademarks. How can the government intend to send both messages? I think this is a weak argument. Why can't government speech be incoherent? Private individuals certainly speak incoherently at times.
• Does private speech become government speech just because the private speech benefits from a government program? Think of copyright law. Can the government refuse copyright protection to books it doesn't like on the grounds that copyright registration is mere government speech? Surely being unable to copyright books would be a still infringement of speech rights, even if writers retained the ability to publish uncopyrighted works.
• Another problem here is the amount of discretion given to the patent examiner. One reason The Slants's trademark application was denied was “ the fact that several bloggers and commenters to articles on the band have indicated that they find the term and the applied-for mark offensive.” Dear God, please let's not make free speech rights dependent on what people on the Internet find offensive. If this were the law, I'm pretty sure staging Othello would be a felony.
• Therefore, trademarks are private speech, and banning disparaging trademarks is unconstitutional viewpoint discrimination. “Giving offense is a viewpoint,” and--I say this at every opportunity--speech may not be prohibited merely because it is offensive.

Psychosomatic illness 5: how do you pick your symptoms?

What determines the type of psychosomatic symptoms a person experiences? Why is it that one person shows up with seizures, another with a numb leg, another with a paralyzed hand?

Personal life experience is a great molder of psychosomatic illness. People learn, probably in childhood or young adulthood, what sort of symptoms get people attention and care. In addition to genetics and environment, this is why certain families tend to be robust or to be sickly. One family's culture is to downplay sickness and keep a stiff upper lip; another family dwells on, analyzes and magnifies every twinge of pain, and gives the sick person a great deal of deference and respect. Children who experience the serious illness of a sibling or a parent are more likely to develop psychosomatic illness, and tend to develop symptoms similar to those of the physically ill relative. Parents pass on strategies that make life easier, whether that means embracing illness or turning to alcohol, drugs or food for comfort.

O'Sullivan says, Early exposure to chronic ill health can inadvertently encourage illness behavior and, as we have seen, shape how psychosomatic illness presents, with patients often suffering from symptoms they have come across before in others. The tendency to respond to every bodily sensation, rather than ignore them as the majority of us do, may be learned at a very young age. They are reacting to symptoms that others might dismiss, and these reactions serve to heighten the symptoms and awareness of them.

Psychosomatic illness 4: Why denial?

What does it look like (and feel like) when someone refuses to accept a diagnosis of psychosomatic illness?

Often, the person denies the possibility of psychosomatic illness, not just because they want to avoid lowering their status, but because they are consciously not aware of any of the stress or trauma that outside observers can identify in their lives. Psychosomatic symptoms are themselves evidence of denial.

Last year I got sick right after graduating from law school; another illness hit me a few weeks later, after my first triathlon. The second illness was pretty bad, and I had no choice but to spend weeks resting, physically and mentally, something I hardly ever do. No more studying or eating or going to the gym or leaving the house; even a visit to the art museum exhausted me. My husband suggested that law school, the triathlon, and studying for the bar might have stressed me out. Ridiculous, I said. Sure, *other* people might find those things difficult, but not me. Look at the statistics. What do I have to worry about?

This is common. When a person denies the possibility of psychosomatic illness, it may be because they fear lowering their status, but it may be because they are consciously not aware of any of the stress or trauma that outside observers can identify in their lives. Psychosomatic symptoms are themselves evidence of denial.

[Patients say] “I had the most wonderful life until I fell ill. I hardly ever had a reason to feel stress.” And I think, how could that be? I have not had a day in my life with no stress at all. In the absolute rejection of stress in these sufferers is there something for us to learn? Ask somebody with dissociative seizures how they feel, and you may get the answer “tired” or “cold”--neither answer containing anything of their emotional state. Perhaps those who deny stress do so because they do not feel stress, having converted it to something else.

Psychosomatic illness 3

How can you tell if someone's suffering is psychogenic?

You can do tests and give the patient a list of normal test results. But tests are imperfect, and “when a person is paralyzed or blind or suffering from convulsions, it is not difficult to see why they find that a very unsatisfactory explanation.“

Very often you can't prove that a person's distress is psychosomatic, especially with vague symptoms like fatigue, pain and weakness. This is one reason why symptoms like these are often undertreated: I thought for years that my daily headaches were the result of the stress I was under, and so did everyone else; turns out I just needed glasses.

There are some facts that tend to suggest that an illness is psychosomatic, however. You can figure out whether the patient is under unusual stress, and if so, whether she is able to consciously acknowledge it. You can look at the patient's history of mental illness or other unexplained symptoms. This is of course a controversial and inaccurate technique; a person's past mental illness doesn't make it impossible for them to later develop physical illness, and what it can seem like to the patient is “you think I'm lying because I had a mental illness”---the standard experience for people labeled mentally ill.

Another technique is to look at the nature of the symptoms--is the symptom consistent with anatomical and biological facts? What treatments does the symptom respond to? O'Sullivan is lucky in that neurological symptoms can be assessed more easily than most.

Conversion disorders are usually a poor mimic of neurological disease. Symptoms that arise through stress or anxiety are produced in the mind and are dependent on what the sufferer understands about the body and disease. The subconscious mind reproduces symptoms that make sense to the individual's understanding of how a disease behaves. In the absence of detailed knowledge of the body, disabilities that arise in the subconscious rarely obey anatomical rules. Aspects of the examination can be assessed objectively, without the participation of the patient.

So, for example, one patient, worrying about a harmless lump on the right side of her head, developed numbness all done the right side of her body. Because she didn't know that the right brain controls the left side of the body, her subconscious had imagined her symptoms wrong.

Another person was unable to straighten his leg when sitting on the exam table. But he was able to use the same quad muscle to stand up from a chair without using his hands, establishing that the muscle weakness was not physically caused.

A third patient was given an injection of botulinum to treat a painful muscle spasm which had incapacitated her hand. Immediately, she reported she was cured--even though the botulinum only takes effect days later.

In the case of psychosomatic seizures—horrifingly common—the cause of the symptoms can be assessed through monitoring the patient's brain waves 24/7 until the person has a seizure. Normal brain function while a seizure is going on rules out epilepsy.

None of these techniques, however, will convince a patient who is firmly in denial. If I don't have epilepsy, maybe I have some previously unknown seizure disorder. Or my subconscious might come up with a new set of symptoms as soon as the previous symptoms have been found psychogenic. And there's always that old standby, “Medical science doesn't know everything, does it?” Even an experienced and tactful doctor like O'Sullivan finds a number of patients walk away, refusing to accept the diagnosis.

Psychosomatic illness 2b

These psychosomatic illness posts are inspired by a recent book by Suzanne O'Sullivan. I've been waiting for this book for a year, and it was worth the wait. The author, a British neurologist, writes about her experiences with the significant minority of her patients who show up with neurological symptoms, such as seizures, paralysis, or numbness, that turn out to be psychogenic. As a neurologist, she has an impressive array of tools that allow her to rule out organic illness, and as an NHS doctor, she seems to be freer to tell patients the truth and to deny them the tests they ask for than the average U.S. doctor.

Psychosomatic illness is treatable—in fact, “if addressed early enough, many of the manifestations of psychosomatic disorders spontaneously disappear without treatment.” But it's hard to treat--first, because the doctor must consider the possibility of psychosomatic illness, and second, because the patient must accept it. The media's narrative about illness doesn't help. When you read about medically unexplained symptoms, the story is: patient suffers, callous doctors can't help, until finally she finds the one doctor who knows what's going on. Doctors' suggestions that the problem may be psychosomatic are treated as insults directed against the patient. (Examples of this kind of narrative can be found at http://wapo.st/2qxCMm2 and http://bit.ly/2pkcswZ).

A patient in the latter article describes how she resisted suggestions of a psychosomatic illness: “When I found out there was an actual physical thing wrong, it was such a relief, because it meant I wasn't just a hypochondriac or a sissy—it was real." She's happy that she has a physical illness, because having a psychosomatic illness would mean being weak and ridiculous. Because she doesn't want to think of herself as weak or ridiculous, she must have a physical illness. She must reject suggestions of psychosomatic illness and go on doctor-shopping until she gets a diagnosis of physical illness. Of course, it's true that doctors are not perfect diagnosticians, and getting a second or third opinion may be a good idea. But we should consider the possibility of a psychosomatic illness as fairly as we consider the possibility of a physical one. In fact, according to the author, it's more common for a psychosomatic illness to be misdiagnosed as physical than the reverse.

And this harms patients. “The more completely somebody has denied the psychiatric diagnosis and imagined a particular physical paradigm to explain an illness, the more prolonged that illness becomes.”

"The harm that comes from incorrectly labeling a psychosomatic illness as organic, while often underestimated, can be immeasurable. If somebody has been told they have epilepsy and has been allowed to believe that they have a serious, potentially life-threatening brain disease, then this belief alone may be so enmeshed in their mind that it affects their ability to recover...It might lead to toxic unnecessary treatment. It might lead a person to make unnecessary life changes to accommodate the disease. But most importantly, the wrong diagnosis will deny the person the correct treatment. When illness functions as a crutch, it may be difficult to relinquish and something is required to take its place. I have told two patients that they had psychogenic seizures and have come back to the ward a day later to find them sporting crutches. Both patients' seizures went into full remission, but neither could walk unaided for several weeks."

The author is full of compassion and useful advice for how to discuss this subject with patients. "The exact manner in which the diagnosis of a psychosomatic condition is delivered is of pivotal importance. Seizures will often disappear completely immediately after the diagnosis has been given--if it has been given well, that is." Hearing that "The tests are normal. There's nothing wrong with you. Go home" is only going to alienate patients without helping them. Psychogenic illness is something wrong, and something that desperately needs to be treated.

Psychosomatic illness 2

What is psychosomatic illness? Here we arrive at a difficulty, because as soon as I start telling you that X Syndrome is psychosomatic, commenters will jump in to tell me that they know X Syndrome isn't psychosomatic, because their friend had it and she was really suffering and how dare I call her a liar?

This is a stupid objection, but I'm not going to get around to explaining why till later. So, for now, let's focus on less controversial examples of psychosomatic symptoms. In the author's words, “physical manifestations of unhappiness are something we all experience; they are not personality flaws or signs of weakness, they are a part of life.” If you know what it's like to cry, or blush, or tremble, or hyperventilate as a result of emotion, these are all examples of how emotions cause physical changes.

Recall the last time you felt psychosomatic symptoms. Notice that you have a very limited degree of control over these symptoms; even if crying or trembling is very embarrassing for you, you can't make the physical manifestation of an emotion go away any more easily than you can make the emotion go away. This ought not to be news to anyone who feels feelings, but it refutes one common objection to the concept of psychosomatic illness, which is along the lines of "My cousin has chronic fatigue syndrome. I've seen her, and she really suffers! She had to drop out of school and give up her favorite hobby! How can you say she's making it up? Why would she do that to herself?"

Psychosomatic illness indeed causes people pain, and sufferers are not lying or consciously making themselves suffer. It's not a pretend illness; it's an illness. As to why a person would do that to themselves, well, read Freud. Or think back to times when you've wanted to punch a wall, or start an argument, or drink till you pass out, or run till you collapse. Our psyches choose one kind of suffering to avoid another. I rate this objection: Completely Wrong.

Psychosomatic illness 1

Psychosomatic illness is one of the greatest causes of suffering in our society--one that is stigmatized, understudied, underdiagnosed, and undertreated when it is diagnosed. If you've never had a psychosomatic illness yourself, you likely know someone who has. On an average day perhaps as many as a third of people who go to see their general practitioner have symptoms that are deemed medically unexplained (quotes are in italics). For most of us, these symptoms are fairly mild: headache, upset stomach, fatigue. For some, the symptoms become crippling and cinematic: paralysis, seizures, inability to talk, loss of memory.

Almost any symptom we can imagine can become real when we are in distress--tremor, fatigue, speech impairments, numbness. Anything. Almost any function of the body can be affected in almost any way. One day a woman loses speech entirely and the next day she speaks in the voice of a child. A girl feels a lump in her throat and becomes convinced she cannot swallow. Eyes close involuntarily and no amount of coaxing or prising will open them. A boy repeatedly drops the ground; every time he stands, he falls. History has seen every one of these things described. [From a 1764 author]: The colours of the chameleon are not more numerous and inconstant than the varieties of the hypochondriac and hysteric disease.

And yet, many observers as well as sufferers reject the concept of psychogenic illness. I hope that this series of posts will elucidate what psychosomatic is, refute some common objections to the post, and give you an idea of when you should consider the possibility that you have it.

Packingham and censorship of sex offenders

Let's talk about Packingham v. North Carolina. May states constitutionally ban convicted sex offenders from using social media? Some points that came up:

• Social media is an important part of modern life. The President uses Twitter to convey breaking news--this law would ban sex offenders from reading the President's Twitter feed. Isn't that excluding sex offenders from fully participating in our polity as informed citizens? Who's going to tell Packingham about the latest dead celebrity?
• On the other hand, there's a lot of precedent for denying people rights after they have been duly convicted of crimes. Going to prison means losing many rights. Not only that, after release you may face indefinite or lifetime loss of certain rights, like the right to vote or right to bear arms. You can lose the latter after only a misdemeanor conviction or even a restraining order! So if we don't sympathize with the guy who slaps his girlfriend and permanently loses his Second Amendment rights, why should we sympathize with the sex offender who loses access to Facebook?
• It's legally irrelevant, but since I brought up sympathy, let's have a moment of sympathy for the "sex offender" in this case, who was put on the registry after having sex with a 13-year-old when he was 21, fifteen years ago. A bad decision, but not bad enough to justify being on a sex offender registry.
• A big reason why Packingham won (spoiler) was the overbreadth of the law. It banned "gaining access to" social-networking sites that allow minors, no matter what you do on those sites, even if you have zero contact with minors, and even if you never post any comment. (Packingham got in trouble after a Facebook post in which he attributed getting out of a couple of traffic tickets to being specially favored by Jesus. I'm no theologian, but I would think once you're a registered sex offender you'd give up on the idea of being favored by God.)
• The law also categorized any site as a "social-networking site" if it allows users to comment and does not ban under-18 users. So not just what you or I would think of as social-networking sites, but most news sites, blogs, job sites, and many commercial sites like Amazon that allow user reviews.
• So a law meant to prevent sex predators from seducing children online ends up banning people from buying shoes on Zappos, looking for apartments on Craigslist, or reading WashingtonPost.com. If the person who wrote the law had drafted more cautiously, this law would have survived as a narrowly tailored "don't contact strange kids online" rule. Why don't people hire me to write these laws? As it is, the law was struck down as an unconstitutional restriction on speech.  

Don't use the courts to force people to like you

Social approval! We all want it. And we're never going to get it--at least, not as much as we want. Whether the people around you approve of you is not within your control. Well, some of it is--you can take some voluntary actions to improve your chances of approval. Being nice and tipping and taking showers helps. But that will never guarantee you get the approval you want.

Why not? Part of it is pure luck--or “privilege,” grudgingly. Part of it is the “you can't please everyone” effect. Being upper-class is generally good, but not if you want to fit in in a lower-class environment. Some people resent immigrants; others think Americans are dumb. Some people will hate you for being black, and others for being white. You can be fat-shamed or skinny-shamed. So, fundamentally, we have to live in a world in which, no matter who you are, some people will hate you for no good reason. A woman has to navigate a world with misogynists and rapists in it. An atheist has to accept that many people think he's going to burn in hell. And gay people have to live with the knowledge that many of their neighbors disapprove of their sexual and romantic relationships. For the person who finds these facts upsetting, I recommend Agent Cooper's mantra.

FBI Agent Roger Hardy: They're liable to extradite you for murder and drug trafficking.

Special Agent Dale Cooper: These are things I cannot control.

This is my problem with the current gay rights movement. As a libertine and libertarian, I have of course been strongly in favor of gay rights as long as I can remember. When gay marriage was banned, and, earlier, when gay sex was illegal, there was a crying need to fight so that gay people can get what they deserve.

But now? Every time I read about a new gay rights case, it's, well, bullying. Suing the small business owner who refuses to sell flowers or cake or custom-printed T-shirts for gay weddings or gay causes. These are not cases about getting gay people what they deserve-- the same privileges and rights the rest of us enjoy. This is using the courts to force the illusion of social approval.

Not even the plaintiffs claim that any person has actually been damaged in these cases. One litigant in a right-to-wedding-flowers case claimed that his actual damages were some $17, or the cost of the gas he burned when he had to drive to a different florist. In another case involving a transgender high school student, the biologically male student wanted to use the girls' locker room; the school wanted him to use the boys' room, and offered the obvious compromise; a private changing room for this student. The offer was rejected--proving, beyond a doubt, that the transgender bathroom controversy is not about providing safe and decent bathroom facilities for transgender people. It's about forcing society to accept the transgender theory of gender. This is completely wrong. Partly, of course, I think it's wrong because my concept of gender is different. But it would be wrong to use the courts to force people to accept my gender theory too! I just have to live in a world in which most people are terribly, terribly, wrong, and, rather than being something the courts ought to correct, this seems like the human condition.

Litigating for social approval is not what the courts are there for. Social approval is not something gay or transgender people deserve, because desserts don't make sense in this context, because social approval is inherently arbitrary.

I wonder if the gay rights advocates agree with me on this point. Is it that they think of approval as something that you are entitled to, if you do x and y? In my life, I've gone from being one of the most stigmatized, powerless and low-status people in our society, to now being reasonably successful and respected. From having to ask dumb people for permission to go to the bathroom to having a job that largely consists of telling smart people what to do. And yet, I feel like the same person. It creates some cognitive dissonance that I've never really known how to communicate. But, other people have not had this experience. If you've always had people approve of you if you did the “right” thing, I imagine you might come to think of approval as something you “deserve.”

Another possibility is that gay rights advocates think of these cases not as means of redressing specific wrongs done to the plaintiffs, but rather as a means of shifting popular opinion. So it's not about fighting for what someone deserves, but rather conducting something of a morality play in which the state of the law is merely a public relations tool.

I would be interested in hearing your opinion, especially if you agree with these gay rights cases. Do you think social approval is something that people deserve? Or do you think these cases are a PR tool? Or do you think our disagreement resides somewhere else?